Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2005
Case ReportsThe use of central neuraxial techniques in parturients with factor V leiden mutation.
The factor V Leiden (FVL) mutation is a leading cause of thrombosis, particularly during pregnancy. During pregnancy, women with thrombotic disorders including FVL are often considered candidates for antepartum anticoagulation with low molecular weight heparin. ⋯ This report focuses on the anesthetic implications that arise in parturients with FVL. We recommend that anesthesiologists be made aware of FVL patients before their due date, anticoagulation with low molecular weight heparin should be transitioned to unfractionated heparin before the 38th gestational week, and multidisciplinary collaborative investigation and care should continue for this disorder.
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Anesthesia and analgesia · Dec 2005
Randomized Controlled TrialClonidine treatment for agitation in children after sevoflurane anesthesia.
Clonidine is effective in treating sevoflurane-induced postanesthesia agitation in children. We conducted a study on 169 children to quantify the risk reduction of clonidine agitation in patients admitted to our day-surgery pediatric clinic. Children were randomly allocated to receive clonidine 2 mug/kg or placebo before general anesthesia with sevoflurane that was also supplemented with a regional or central block. ⋯ Pain and discomfort scores were significantly decreased in the clonidine group; the incidence of agitation was reduced by 57% (P = 0.029) and the incidence of severe agitation by 67% (P = 0.064). Relative risks for developing agitation and severe agitation were 0.43 (95% confidence interval, 0.24-0.78) and 0.32 (0.09-1.17), respectively. Clonidine produces a substantial reduction in the risk of postsevoflurane agitation in children.
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Anesthesia and analgesia · Dec 2005
Postdischarge symptoms after ambulatory surgery: first-week incidence, intensity, and risk factors.
Minor sequelae, such as pain, nausea, and drowsiness, often occur in surgical outpatients in the immediate postdischarge period. In this prospective, observational study was defined the daily incidence and intensity of several symptoms during the first week after surgery and determined predictive factors of minor morbidity. In two similar mixed ambulatory surgery units, 3910 patients received a questionnaire to grade daily the intensity of predefined symptoms on a 4-point scale. ⋯ Drowsiness was most common in children. Younger adults, older children, and women were more prone to experience minor morbidity. Longer duration of surgery led to increased likelihood of pain and nausea in all patients and increased the risk of several other symptoms in adults.
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Anesthesia and analgesia · Dec 2005
Airway protective reflexes evoked by laryngeal instillation of distilled water under sevoflurane general anesthesia in children.
To investigate how sevoflurane modifies airway protective reflexes in anesthetized children, we recruited patients younger than 12-yr-old for our study. Anesthesia was induced with inhaled sevoflurane in oxygen. The airway was managed with a laryngeal mask airway and the patient breathing spontaneously. ⋯ Ten subjects were included in each group. In both groups, the primary responses were passive; however, in Group 1, active reflexes were also observed in 8 of 10 subjects; no subjects in Group 2 had active reflexes (P < 0.01). We concluded that, in children, the depth of general anesthesia with sevoflurane modified airway protective reflexes.
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Anesthesia and analgesia · Dec 2005
Case ReportsPersistent cauda equina syndrome with no identifiable facilitating condition after an uneventful single spinal administration of 0.5% hyperbaric bupivacaine.
We diagnosed cauda equina syndrome 15 h after uneventful single spinal administration of 0.5% hyperbaric bupivacaine 12.5 mg through a 27-gauge pencil-point type needle. No preexisting neurologic disorder was recorded. ⋯ Resolution of most of the symptoms occurred within a few days but some foot drop persisted for 2 yr after the procedure. Bupivacaine neurotoxicity is suggested by the absence of any other identifiable cause for this neurologic deficit.